Provider Demographics
NPI:1053641621
Name:BANDMAN, KIMBERLY JILL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JILL
Last Name:BANDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6420
Mailing Address - Country:US
Mailing Address - Phone:917-881-2079
Mailing Address - Fax:
Practice Address - Street 1:44 JAMES ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6420
Practice Address - Country:US
Practice Address - Phone:917-881-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical